Ellis Burke Jardine, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE60339865 Issued in WA

Practice address

406C SE 131St Avenue
Suite 305
Vancouver, WA 98683-4003

Phone

(360) 253-9792

NPI assigned

Jun 27, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ellis Jardine, DMD, PLLC

  dba Excel Dental

  • Prosthodontics
  • Battle Ground, WA
  • NPI 1831558907
  Medicare reassignment NPD Authorized official
• Columbia Ebj LLC

  dba Excel Dental

  • Prosthodontics
  • Battle Ground, WA
  • NPI 1821456419
  Authorized official Same address or phone
• Ellis Burke Jardine, DMD, PC

  dba Advanced Dental Specialists

  • Prosthodontics
  • Vancouver, WA
  • NPI 1720458359
  NPD (past) Authorized official
• Sharma-Bhui Excel Dental, P.S.

  • Dentist
  • Battle Ground, WA
  • NPI 1205152766
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922205715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3542 NE FRANKLIN ST",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986076904",
            "telephone_number": "480-862-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406C SE 131ST AVENUE",
            "address_2": "SUITE 305",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834003",
            "telephone_number": "360-253-9792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARDINE",
        "first_name": "ELLIS",
        "middle_name": "BURKE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2023-03-07",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "7240",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "27917",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WA",
            "license": "DE 60339865",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TN",
            "license": "9441",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE60339865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler John Jansen, PSYD
• Lisa Janssen Carlson, PHARMD, RPH
• Dawn Marie Januik, RDH
• Janus of SW Washington (Val Ogden Center)
• Stephen Jardin, LMP
• Olivia Jarett, PA-C
• Cailin Kelly Jarrell, FNP-BC, PMHNP-BC
• Jessica Danielle Jarrett, ND
• Jason D. Mah DMD PLLC
• Jason Paul Jarria, MD, PLLC

• Oral and Maxillofacial Surgery (Dentist) in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.